Chronic eosinophilic pneumonia (CEP) is an idiopathic disorder characterized by an abnormal and marked accumulation of eosinophils in the interstitial and alveolar spaces of the lung. Idiopathic chronic eosinophilic pneumonia is reported to comprise anywhere from 0-2.5% of cases within the registries of interstitial lung disease. Diagnosis is based on the clinical constellation of symptoms, characteristic radiographic findings and peripheral blood or BAL eosinophilia, in the absence of infection or drug-induced eosinophilia. There is no consensus on the dose and duration of treatment, but most authors recommend initial doses of prednisone at 0.5–1 mg/kg/day with gradual tapering of the dose for total treatment duration of 6–12 months.

Introduction: Most patients undergoing a left atrial appendage occlusion (LAAO) procedure are admitted for overnight observation. A same-day discharge strategy offers the opportunity to improve resource utilization without compromising patient safety. We compared the patient safety outcomes and post-discharge complications between same-day discharge versus hospital admission (HA) (>1 day) in patients undergoing LAAO procedure.Methods: A systematic search of MEDLINE and Embase was conducted. Outcomes of interest included peri-procedural complications, re-admissions, discharge complications including major bleeding and vascular complications, ischemic stroke, all-cause mortality, and peri-device leak >5 mm. Mantel-Haenszel risk ratios (RRs) with 95% CIs were calculated.Results: A total of seven observational studies met the inclusion criteria. There was no statistically significant difference between same-day discharge versus HA

Euglycemic Diabetic ketoacidosis (DKA) is a rare complication in type II Diabetic patients who are taking sodiumglucose cotransporter-2 (SGLT-2) inhibitors. We present a case of euglycemic DKA in a type II diabetic patient taking SGLT-2 inhibitors with a positive Severe Acute Respiratory Syndrome-Coronavirus 2 (SARS-CoV2) infection that was diagnosed early and treated with subcutaneous short-acting insulin. A 57-year-old man presented to our emergency department for sudden fall and dysarthria with a few days history of shortness of breath, fever and nausea. CT head at presentation showed segmental occlusion of right internal carotid artery(ICA). Nasal swab was positive with SARS-CoV2 PCR. Initial labs remarkable for bicarbonate of 17 meq/L, arterial pH 7.14 with an anion gap of 17 and PCO2 was 41. His serum blood glucose was 248mg/dl and lactate at 1.0 mmol/L. His past medical history was significant for type II diabetes (on Empagliflozin and Metformin) and extensive coronary artery disease with multiple stents, on dual anti-platelet therapy (DAPT). He underwent interventional radiology (IR) guided thrombectomy of right ICA and was admitted to ICU for post-stroke care. Due to aforementioned labs, we immediately checked his serum ketones which were elevated at 0.58mmol/L and the diagnosis of euglycemic-DKA secondary to SGLT-2 inhibitor use was made. Since the metabolic acidosis and ketonemia were still fairly in the early stages, we decided to manage it with subcutaneous short-acting insulin. The anion gap was closed within the next 12 hours. Euglycemic DKA is a known complication of SGLT-2 inhibitors with high morbidity and mortality. The reported incidence of euglycemic DKA with empagliflozin is 0.2 to 0.6 per 1,000 patient-years. Recently, a few case reports have been published sharing a correlation with SARS-CoV2 infection. This infection causes a state of profound inflammation and stress, making lab values in these patients widely deranged which can muddle the clinical picture. Since this infection also worsens the glycosuria seen with the use of SGLT-2 inhibitors, ICU physicians must pay close attention to this complication in diabetic patients. We propose that the incidence of developing euglycemic DKA with SGLT-2 inhibitor use may be higher in SARS-CoV2 infection and more research may prove a positive correlation between the two.

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